Posted on March 31, 2021

By Angela Rapp Kennedy, CQL Vice President of Systems Transformation

We know how critical understanding and exercising rights is to the quality of people’s lives – a quick review of the data we share in this Capstone makes that obvious. While most organizations understand that, it may be difficult to know what concrete actions to take to support people to learn about and exercise their rights. I often joke that no CQL training would be complete without a Three E’s slide and here again that is true.

In the January Capstone the Three E’s, Education, Experience and Exposure were discussed. Here in relation to rights, they are once more so useful. As you discover more about rights from the perspective of the people you support through Personal Outcome Measures® interviews, right assessments, etc. the Three E’s can guide which activities you might undertake. That may include developing and providing a variety of educational opportunities for people supported and staff, as well as increasing experience and exposure to assist people supported with true and meaningful informed choices. Perhaps some of all the above.

Tips For Applying The Three E’s To Rights

Here is a list, not exhaustive by any means, of possible activities an organization might undertake in the pursuit of increasing people’s opportunities to learn about and exercise their rights:

• Schedule in-person and/or online classes for both people supported and DSPs
• Institute an organization-wide ‘Right of The Month’ with various activities
• Update/revise your rights handbook to be more accessible, perhaps even putting it online to make it more interactive
• Include people supported in staff training regarding rights and other topics
• Include people supported in the hiring and training of the staff
• Include people supported on all of the various committees of the organization
• Discuss rights at house meetings
• Support people to participate in self-advocacy groups – internally and externally
• Use Tik Tok, Quillo, and other platforms to create short, fun videos about rights
• Have a weekly game night with people supported and staff using the CQL Rights Conversation Cards
• Play charades trying to guess different rights
• Support people to explore community organizations who might be looking for board and/or committee members
• Create online games regarding rights, using free sites such as jeopardylabs.com for staff and people supported to play together
• Use short videos such as those found on the CQL website to start a conversation at a staff meeting, house meeting, or with other small groups:

To consider further how to integrate the use of the Three E’s in your efforts to support people to learn about and exercise their rights we turn to two former CQL Awards of Excellence recipients for examples. Take this opportunity as you read about how the Three E’s were employed (maybe a fourth E 🙂) to impact people’s lives at CHI Friendship and Core Services of Northeast Tennessee, to consider the next steps for you and your organization.

Rights & Overall Quality Of Life

By Carli Friedman, Ph.D., CQL Director of Research

Through our analyses of Personal Outcome Measures® interviews with thousands of people with disabilities, we’ve found the impact of exercising rights can be widespread. For example, in our social determinants of health research, we’ve found:

• When people have the right to personal decision-making, emergency department visits decrease by 47%.
• When people have the right to visitors, abuse and neglect incidents decrease by 57%.
• When people have the right to personal decision-making, behavior events decrease by 69%.

Not only does exercising rights significantly improve people’s health and safety, it also leads to a better overall quality of life. People who exercised rights in 2020 had more than double the quality of life outcomes present compared to people who did not exercise rights.

The Impact of Rights on Quality of Life (2020)

Despite the fact that people with disabilities are entitled to human and civil rights, and the benefits of exercising rights on outcomes, less than half of people interviewed in 2020 were supported by organizations to exercise their rights.

Exercise Rights: Supports In Place (2020)

Organizational supports are key to ensuring people are able to exercise their rights. In fact, people with disabilities are 27 times more likely to exercise their rights when organizational supports are in place. By supporting people with disabilities to exercise their rights, organizations are not only honoring people’s rights, but also, by extension, helping to improve people with disabilities’ health, safety, and quality of life.

Electing To Use The Three E’s

By Dori Leslie, President, CHI Friendship

CHI Friendship uses the “Three E’s” to assist people to guide their own lives in the least restrictive environment through rights restoration. With education, experience, and exposure, people with disabilities are able to broaden their horizons by gaining knowledge and increasing choices and decision-making.

Given that 2020 was an election year, this provided great opportunities for CHI Friendship to educate people on their right to vote more than ever before. CHI Friendship’s initiative focused on teaching people how to fill out a ballot, mail in the ballot, vote in person, and use an adaptive ExpressVote machine. CHI Friendship also developed an unbiased cheat sheet to assist staff in teaching people supported about the candidates and ballot measures.

Exposure Through Mock Election Days

“Mock Election Days” were offered and allowed people to practice voting by gaining exposure to the voting booths, ballots, and the voting process. After practicing voting during a Mock Election Day, one person explained how he was finally comfortable and excited to vote for the very first time! CHI Friendship saw substantial growth in voter turnout in 2020 compared to previous elections.

The presidential election in 2020 saw 37% of people supported at CHI Friendship vote, which was up over 30% from previous elections. The higher turnout is attributed to the practices that were put in place in 2020 to allow for people to gain more education, experience, and exposure to the voting process.

Education About Supported Decision-Making (SDM)

CHI Friendship has also implemented several processes to ensure we are providing education on all aspects of Supported Decision-Making (SDM). 100% of all stakeholders, including each person supported, have received education on SDM. CHI Friendship provides exposure and education through conversations at team meetings, webinars, and the use of guides to make the complex topic of SDM more understandable. During a SDM meeting, one gentleman stated that he wanted support picking out clothing and food, but was adamant that he did not want support while in the bathroom. He was able to guide his own SDM meeting to determine what supports he wanted, as well as where he wanted more independence.

With these two initiatives, we saw situations of immediate interest. Many people were excited to vote and some people have SDM as an alternative to guardianship. But we also saw different levels of disinterest where others did not want to vote or to consider other options with guardianship. We understand that our responsibility is to provide the education, experience, and exposure, and then let the person make the ultimate decisions for their own life.

Independence Through The Three E’s

By Susan Arwood, Executive Director, Core Services of Northeast Tennessee

Bradley, age 34, came to Core Services after living in a supported living model with 24/7 direct support professional (DSP) supports at another agency. Bradley had dreams of greater independence. Shortly after coming to Core Services, Bradley participated in a 4-week responsibility class where he learned about exercising his rights as well as the responsibilities that go along with those rights. From the knowledge gained in the class, Bradley advocated for himself with his conservator and independent support coordinator to have times when he could be home alone.

Advocating For An Apartment

Bradley enjoyed this independence and wanted more of it. At Bradley’s request the agency arranged for Bradley to spend time with an individual who was living semi-independently in an apartment, with a combination of technology and paid supports. Bradley liked what he saw and requested a circle of support meeting to advocate for the lifestyle he desired. He took his father to see the apartment that had technology supports and convinced his father he was ready for a similar opportunity. When an opportunity came open at a technology apartment, a plan was written that included fading DSP support.

This allowed the opportunity for Bradley to experience life without overnight staff in a tier process. For the past three months Bradley has enjoyed his new lifestyle and has aspirations to eventually live alone with minimal supports.

Next Steps In Promoting Rights Using The Three E’s

By Angela Rapp Kennedy, CQL Vice President of Systems Transformation

As we’ve shared in this Capstone exercising rights can have a significant impact on people’s quality of life – and as our research indicates – organizations play a pivotal role in supporting this indicator. The Three E’s are an essential framework for promoting rights with people receiving services.

CQL has produced numerous resources about rights – including guides, webinars, articles, and more. These resources can be used to ensure that people have the education, experience, and exposure necessary to exercise their rights. Along with these resources, we hope that you’ll identify new and innovative ways to integrate the Three E’s into your supports and services!